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Meyer ER, Cui D. Using Stereoscopic Virtual Presentation for Clinical Anatomy Instruction and Procedural Training in Medical Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1431:145-160. [PMID: 37644291 DOI: 10.1007/978-3-031-36727-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This chapter begins by exploring the current landscape of virtual and augmented reality technologies in a post-pandemic world and asserting the importance of virtual technologies that improve students' learning outcomes while also reducing costs. Next, the chapter describes clinical anatomy instruction concepts in medical education, including applied anatomy content knowledge, pedagogical anatomy content knowledge, and virtual stereoscopic visualization studies that exemplify these concept areas, respectively. The chapter then explores the concept of procedural training with a specific emphasis on virtual stereoscopic anatomy visualization studies that exemplify or have implications for procedural training in medical education. Subsequently, the chapter discusses the benefits and challenges as well as the potential future positive and negative implications of virtual stereoscopic visualizations in medical education before finally concluding with some pensive considerations for the present and future of anatomy education and training using virtual technologies.
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Affiliation(s)
- Edgar R Meyer
- Department of Advanced Biomedical Education, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Dongmei Cui
- Department of Advanced Biomedical Education, University of Mississippi Medical Center, Jackson, MS, USA
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Safe Zone for Dissection in Frontotemporal Region to Avoid Injury to the Temporal Branch of Facial Nerve. J Craniofac Surg 2021; 32:2322-2325. [PMID: 34705381 DOI: 10.1097/scs.0000000000007668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The objective of this study is to provide a reliable roadmap for temporal branch of the facial nerve, in order to minimize, the risk of injury to the nerve during surgical dissections. A literature search was conducted on temporal branch of facial nerve. The date search range was 1950 to 2017. Databases searched included Medline, Web of science, Biosis, SciELO, Data Citation, and Zoologic Records. Data were collected on, author specialty, date of publication, and the relationship of the temporal branch of facial nerve to various landmarks in the frontotemporal region reported in human anatomic studies. Among the 48 studies reviewed, a total of 3477 anatomic dissections were performed in the craniofacial region. Temporal branch of facial nerve was located between 2.5 and 3 cm from lateral orbital rim. In relation to the zygomatic arch, it was found anywhere from the midpoint of the arch to 1 finger breath posterior to the arch. For the plane, it was most commonly described as being under the superficial temporal fascia (STF) or within the loose areolar tissue. Most anatomic dissections found 2 to 4 twigs of the temporal branch of facial nerve. In relation to the lateral canthus, it was found to be 2.85 +/- 0.69 cm superior and 2.54 +/- 0.43 cm lateral to the lateral canthus. Our study suggests consolidated data on surgical landmarks in order to ensure safe dissection in temporal region and prevent injury to the temporal branch of facial nerve.
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Zourntou SE, Makridis KG, Tsougos CI, Skoulakis C, Vlychou M, Vassiou A. Facial nerve: A review of the anatomical, surgical landmarks and its iatrogenic injuries. Injury 2021; 52:2038-2048. [PMID: 34074487 DOI: 10.1016/j.injury.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/09/2021] [Accepted: 05/16/2021] [Indexed: 02/02/2023]
Abstract
Facial nerve iatrogenic injuries are serious and can negatively affect the quality of life of the patients. Due to the properties of the nerve, the complications are devastating involving the aesthetic appearance and the function of the face. Moreover, the multiple branches of the nerve increase the risk of an iatrogenic injury making the detailed knowledge of the anatomical correlations around them critical. In this review, a meticulous analysis was performed including the surgical procedures posing the greater risk of an iatrogenic injury as well as the full description of all the reported anatomical landmarks involving the extracranial course of the facial nerve.
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Affiliation(s)
| | | | | | - Charalampos Skoulakis
- Otolaryngology Department Neurology & Sensory Organs, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Marianna Vlychou
- Radiology Department Clinical and Laboratory Research, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Aikaterini Vassiou
- Anatomy Department Morphology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
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Kucukguven A, Ulkir M, Bilgic Kucukguven M, Demiryurek MD, Vargel I. Defining a Preauricular Safe Zone: A Cadaveric Study of the Frontotemporal Branch of the Facial Nerve. Aesthet Surg J 2021; 41:398-407. [PMID: 32770215 DOI: 10.1093/asj/sjaa232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In the preauricular region, the frontotemporal branch of the facial nerve is vulnerable to injury, which can result in facial palsy and poor cosmesis after surgical interventions. OBJECTIVES The purpose of this study was to describe variations in the branching patterns of the frontotemporal branch of the facial nerve and the relation between this branch and the surrounding anatomic landmarks. Based on our findings, we propose a Danger Zone and Safe Zones for preauricular interventions to avoid frontal branch injury. METHODS Twenty cadaveric half-heads, 10 freshly frozen and 10 embalmed, were dissected. The anatomy of the auriculotemporal nerve, facial nerve, and variations of its branching pattern in the preauricular region were investigated. RESULTS The mean [standard deviation] number of frontotemporal branches crossing the zygomatic arch was 2.05 [0.6]. Beginning from the X point at the apex of the intertragal notch, frontal branches ran over the zygomatic arch at a distance extending from 10 to 31 mm anterior to the tragus, which can be defined as the Danger Zone for frontal branches. Safe Zones A and B are triangular regions located behind and in front of the Danger Zone, respectively. CONCLUSIONS Mapping of these Safety and Danger Zones is a reliable and simple approach in preauricular interventions to avoid frontal branch injury because the facial nerve typically has multiple frontal branches. This approach provides practical information for surgeons rather than estimating the trajectory of a single frontal branch from Pitanuy's line.
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Affiliation(s)
- Arda Kucukguven
- Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Ankara, Turkey
| | - Mehmet Ulkir
- Hacettepe University Faculty of Medicine, Department of Anatomy, Ankara, Turkey
| | - Meric Bilgic Kucukguven
- Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | | | - Ibrahim Vargel
- Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Ankara, Turkey
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Pankratz J, Baer J, Mayer C, Rana V, Stephens R, Segars L, Surek CC. Depth Transitions of the Frontal Branch of the Facial Nerve: Implications in SMAS rhytidectomy. JPRAS Open 2020; 26:101-108. [PMID: 33251317 PMCID: PMC7680882 DOI: 10.1016/j.jpra.2019.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/30/2019] [Indexed: 11/28/2022] Open
Abstract
Background Anatomy of the frontal branch of the facial nerve relative to the zygomatic arch and the superficial musculoaponeurotic system (SMAS) has been well described. The variability centers on the location where the frontal branch traverses from a deeper to more superficial plane in the SMAS. The goal of this study is to examine the depth transition of the frontal branch of the facial nerve relative to the zygomatic arch with hopes of pinpointing a caution zone for dissection to avoid nerve injury. Methods The frontal branch of the facial nerve was dissected in 36 hemifacial fresh cadaver specimens. Pitanguy's line, the zygomatic arch, and temporal crest were marked. Measurements were taken from the zygomatic arch to the location where the frontal branch pierced the temporoparietal fascia. Locations of the superficial temporal artery (STA), the frontal branch cross relative to the lateral orbital rim and frontalis muscle were also measured. Results In 94.4% (n = 36) of the specimens, the frontal branch was found to transition to an intra-SMAS plane approximately 9.6 mm above the zygomatic arch. In all specimens, the frontal branch transitioned to an intra-SMAS plane approximately 12.2 mm posterior to Pitanguy's line. Conclusions This study describes a surgical "caution zone" centered on a point 9.6 mm above the arch and 12.2 mm posterior to Pitanguy's line, and related to the anterior branch of the STA. We hope this anatomical detail will help to decrease the likelihood of intraoperative injury to the frontal branch of the facial nerve.
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Affiliation(s)
- Joseph Pankratz
- Department of Anatomy, Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106 US
| | - Jacob Baer
- Department of Anatomy, Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106 US
| | - Catherine Mayer
- Department of Anatomy, Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106 US
| | - Viren Rana
- Department of Anatomy, Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106 US
| | - Robert Stephens
- Professor of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, MO 64106 US
| | - Larry Segars
- College of Biosciences, Kansas City University of Medicine and Biosciences, Kansas City, MO 64106 US
| | - Christopher C Surek
- Surek Plastic Surgery, Clinical Assistant Professor, Department of Plastic Surgery, University of Kansas Health System, Assistant Professor of Anatomy, Kansas City University of Medicine and Biosciences US
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Green Sanderson K, Conti A, Colussi M, Connolly C. A Simple Clinical Application for Locating the Frontotemporal Branch of the Facial Nerve Using the Zygomatic Arch and the Tragus. Aesthet Surg J 2020; 40:NP223-NP227. [PMID: 31254463 DOI: 10.1093/asj/sjz186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The seventh cranial nerve (CN VII), also known as the facial nerve, is an anatomically intricate structure the branches of which serve several physiologic functions. CN VII innervates the muscles of facial expression which are crucial for eye protection, oral competence, and social interaction. The temporal branch, clinically referred to as the frontotemporal branch (FTB), is the most superior of the 5 branches and is at risk during cutaneous surgery of the parotid gland and in the temporal region. Several methods for delineating the FTB trajectory exist, the most widely known being Pitanguy's Line, which is defined as running from 0.5 cm below the tragus to 1.5 cm above the lateral eyebrow. However, variations in eyebrow location, often affected by modern-day cosmetic trends, complicate the accuracy of this approach. OBJECTIVES The aim of this study was to develop a surgical landmark to identify FTB location without relying on soft tissue structures. METHODS To minimize variation, we chose landmarks that were both consistent and easy to locate based on simple surface anatomy. Twenty-one cadaver hemifaces were dissected in order to locate the FTB in relation to the inferior border of the zygomatic arch and the apex of the tragus. RESULTS We found that the mean ± SEM distance from the apex of the tragus to the point where the FTB crossed the inferior border of the zygomatic arch was 3.21 ± 0.05 cm. CONCLUSIONS Through the use of this measurement, we aim to avoid the pitfalls of previous techniques by providing a widely applicable clinical tool based on landmarks easily found on any patient. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Kit Green Sanderson
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alyssa Conti
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mariah Colussi
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cara Connolly
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Kehrer A, Engelmann S, Ruewe M, Geis S, Taeger C, Kehrer M, Prantl L, Tamm E, Bleys RR, Mandlik V. Anatomical study of the zygomatic and buccal branches of the facial nerve: Application to facial reanimation procedures. Clin Anat 2019; 32:480-488. [DOI: 10.1002/ca.23332] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/16/2018] [Accepted: 01/05/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Reconstructive, and Hand SurgeryUniversity Hospital Regensburg Regensburg Germany
| | - Simon Engelmann
- Department of Plastic, Reconstructive, and Hand SurgeryUniversity Hospital Regensburg Regensburg Germany
| | - Marc Ruewe
- Department of Plastic, Reconstructive, and Hand SurgeryUniversity Hospital Regensburg Regensburg Germany
| | - Sebastian Geis
- Department of Plastic, Reconstructive, and Hand SurgeryUniversity Hospital Regensburg Regensburg Germany
| | - Christian Taeger
- Department of Plastic, Reconstructive, and Hand SurgeryUniversity Hospital Regensburg Regensburg Germany
| | - Michael Kehrer
- Department of Trauma SurgeryUniversity Hospital Bonn Bonn Germany
| | - Lukas Prantl
- Department of Plastic, Reconstructive, and Hand SurgeryUniversity Hospital Regensburg Regensburg Germany
| | - Ernst Tamm
- Institute of Human AnatomyUniversity of Regensburg Regensburg Germany
| | | | - Veronika Mandlik
- Department of Plastic, Reconstructive, and Hand SurgeryUniversity Hospital Regensburg Regensburg Germany
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De Bonnecaze G, Vergez S, Chaput B, Vairel B, Serrano E, Chantalat E, Chaynes P. Variability in facial‐muscle innervation: A comparative study based on electrostimulation and anatomical dissection. Clin Anat 2018; 32:169-175. [DOI: 10.1002/ca.23081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/11/2018] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Affiliation(s)
- G. De Bonnecaze
- Department of Head and Neck SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
- Department of AnatomyUniversity of Toulouse CHU Rangueil‐Larrey France
| | - S. Vergez
- Department of Head and Neck SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
| | - B. Chaput
- Department of Plastic and Aesthetic SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
| | - B. Vairel
- Department of Head and Neck SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
| | - E. Serrano
- Department of Head and Neck SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
| | - E. Chantalat
- Department of AnatomyUniversity of Toulouse CHU Rangueil‐Larrey France
| | - P. Chaynes
- Department of AnatomyUniversity of Toulouse CHU Rangueil‐Larrey France
- Department of NeurosurgeryUniversity of Toulouse, Pierre‐Paul Riquet Hospital France
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The Relationship of the Temporal Branch of the Facial Nerve to the Fascial Planes of Temporal Region in Human Fetuses. J Craniofac Surg 2017; 28:2151-2154. [DOI: 10.1097/scs.0000000000003975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Davies JC, Ravichandiran M, Agur AM, Fattah A. Evaluation of clinically relevant landmarks of the marginal mandibular branch of the facial nerve: A three-dimensional study with application to avoiding facial nerve palsy. Clin Anat 2015; 29:151-6. [PMID: 26096443 DOI: 10.1002/ca.22570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 11/05/2022]
Abstract
Injury to the marginal mandibular branch of the facial nerve (MMN) during surgery often results in poor functional and cosmetic outcomes. A line two finger breadths or 2 cm inferior to the border of the mandible is commonly used in planning neck incisions to avoid injury to the MMN. The purpose was to compare the two finger breadth/2 cm landmarks in predicting MMN course, and their accuracy/reliability. Thirty-one cadaveric specimens were scanned to obtain 3D surface topography (FARO® scanner). Four independent raters pinned the inferior border of the mandible and a two finger breadth line and 2cm line below. The location of each pin was digitized (Microscribe™). A preauricular flap was raised, and MMN branches were digitized and modelled (Geomagic®/Maya®) enabling quantification of the accuracy of these landmarks. The location of the two-finger breadth line was variable, spanning 25-51 mm below the inferior border of the mandible (ICC = 0.10). The most inferior MMN branch did not pass below the two-finger breadth line in any specimen, but a narrow clearance zone (≤5 mm) was found in two. In contrast, in 7/31 specimens, the most inferior MMN branch coursed below the 2 cm line and would be at risk of injury. It was concluded that an incision two finger breadths below the inferior border of the mandible could provide safer access than the 2 cm line. After an incision has been placed using the two finger-breadth landmark, caution must be exercised during dissection as branches of the MMN may lie only a few millimeters superior to the incision.
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Affiliation(s)
- Joel C Davies
- Division of Anatomy, Department of Surgery, University of Toronto, Ontario, M5S 1A8, Canada
| | | | - Anne M Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Ontario, M5S 1A8, Canada
| | - Adel Fattah
- Facial Nerve Programme, Regional Paediatric Burns and Plastic Surgery service, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK
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Leckenby JI, Grobbelaar AO. Facial reanimation. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cornwall J. Perhaps we don't know what we thought we knew: Why clinicians need to re-visit and re-engage with clinical anatomy. Australas Med J 2013; 6:339-40. [PMID: 23837082 DOI: 10.4066/amj.2013.1676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jon Cornwall
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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Wang Y, Hackel D, Peng F, Rittner HL. Long-term antinociception by electroacupuncture is mediated via peripheral opioid receptors in free-moving rats with inflammatory hyperalgesia. Eur J Pain 2013; 17:1447-57. [PMID: 23649949 DOI: 10.1002/j.1532-2149.2013.00325.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Electroacupuncture (EA) has been widely accepted and applied as an important acupuncture-related technique for acupuncture analgesia (AA) research. The involvement of opioid peptides and receptors in acute AA has been shown via pre-EA application of opioid receptor/peptide antagonists. In this study, we intended to reproducibly institute acupoint position and needling excluding influences from anaesthesia or restrainers on rats with complete Freund's adjuvant (CFA) hind paw inflammatory pain, as well as to explore opioid-dependency and anti-inflammatory effects in sustained acupuncture analgesia. METHODS Accurate position and needling approach on acupoint GB30 was modelled by computer-based three-dimensional (3D) images and followed by an optimal EA treatment protocol (100 Hz, 2-3 mA, 20 min) at 0 and 24 h post-CFA in conscious free-moving rats. Opioid receptor antagonists, naloxone (NLX) and naltrindole (NTI) were applied intraplantarly post-EA at late phase (96 h) of CFA. Nociceptive thresholds were assessed by paw pressure threshold (Randall-Sellito) or paw withdrawal latency (Hargreaves), and anti-inflammatory effects were evaluated by measurement of plantar temperature and paw volume. RESULTS EA elicited significant sustained mechanical and thermal antinociception up to 144 h. Mechanical antinociception of EA was suppressed by peripheral intraplantar application of NLX and NTI. EA also reduced paw temperature and volume during the same time frame indicating anti-inflammatory effects. CONCLUSIONS By employing a reproducible EA treatment model on GB30 in free-moving rats, we demonstrated the involvement of peripheral opioid receptors mediated EA-induced long-term antinociception. Future studies should examine the specific neuroimmunological connection of EA-induced sustained antinociception in inflammation.
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Affiliation(s)
- Y Wang
- Department of Anesthesiology, University Hospital of Würzburg, Germany
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